As you may know, infection control today goes without saying--hand washing, cover your mouth when you cough, use sterile everything when doing surgery...

So obvious, right?

'Twas not always so. Hold on to your hats, yo.

Medieval Era (5th to 15th Centuries)
For background, remember that in the mid 1300's, the bubonic plague killed 1/3 of the population in Europe.

Hospital death rates were so high that sometimes a requiem mass was held for people entering the hospital, as if they'd already died. (Can we say "glass half empty" any louder?)

Some wounds were treated with cautery. A burning iron was pushed into a wound until it hit bone, or boiling oil and treacle was poured into the wound. (And you though salt was bad.)

Corpse removal was not immediate. We take this for granted. During this time, immediate removal would be thought odd. Sometimes, bodies in rigor mortis remained in the same bed with with other living patients for over 24 hours. (*looks for trashcan; dry heaves*)

Early Modern Era (1500-1800)
Infectious diseases continue to be the most common cause of death in Europe and the U.S. Yellow fever hit, (you must read Laurie Halse Anderson's Fever 1793 for a great fictional account of this time), measles and smallpox were serious killers, and massive outbreaks of cholera hit in the early 1800s.

The first "clinical trial" for smallpox happens in 1796--an 8 y/o boy is inoculated with blisters from a milkmaid with cowpox. The boy then survives a smallpox challenge.

Bloodletting is a common form of treatment. One woman is described to have been bled 1309 times before dying at age 31. (Gee. I wonder why she didn't make it to #1310.)

Most women undergoing Cesarean section died.

40% of those undergoing amputation died from infection. Most instruments such as metal probes and saws were not cleaned between patients and were caked with pus and blood. (Under these circumstances, 60% survival rate is not that bad...)

There is a proposal to ban spitting on the hospital wards. (Yay! Personally, I'd like to ban spitting all the time.)

This paper is such a great find for writers doing any historical research! Healthcare is always an issue in historical fiction. If you would like to read more, you can download the PDF here.
("Infection control through the ages." Smith et al. American Journal of Infection Control. 2012; 40:35-42)

Congrats Phil, Kristen, and Dr. Hewlett on your publication, and thank you for doing all that exhaustive research!

I hope some of you will find this helpful if you ever need research for your novels during any of these eras. Happy Monday!

If you've got a fictional medical question, let me know! Post below or email me at All I ask is that you become a follower and post a link on your blog when I post your answer. This is for fictional scenarios, only. Please check out the boring but necessary disclaimer on my sidebar ---> Also, don't forget to stop by Laura Diamond's Mental Health Mondays and Sarah Fine's The Strangest Situation for great psychiatric and psychological viewpoints on all things literary. :)

Urrghh. One of my books is set in 1867, and I consulted a guns expert on how I could arrange for one of my characters to survive a gun shot to the chest. He suggested a shoulder wound, but cautioned the ball (bullet) would have to be removed under as sanitary conditions as I could make believable.

I researched the heck out of it, trying to save my character, and determined that enough medical articles on washing one's hands and one's surgery instruments had been written by 1867 that a young doctor might've been convinced -- although most older doctors would've believed it to be hogwash.

Thanks! I needed a good 'yuck, yuck' this morning. I think the one practiced that really grossed me out when I read about it was when doctors didn't wash their hands after delivering a baby, then would go to the next poor mother and delivered hers. Many women didn't survive the infection. Glad I didn't live in any of those times because I'm so germaphobic. But then, maybe I would have invented sterlization? :)

Omg...omg omg omg...UGGGH!! What the hell!? The same dirty instruments?! SPITTING!? Umm...duh, much!? Ouuuhhh...I already told my husband, yesterday actually, that if I ever got a severe injury that needed cauterization for some reason, just let me die. There is nooooooo freaking way I'm doing that junk. OOKIE! But still cool!!! I think I'm morbid, like that. This stuff is always fascinating!

Fascinating stuff. Half the time, we don't realize just how far we've come or how lucky we are to be living at this particular time. Can't imagine watching one of my limbs being amputated. Cauterization much have felt like hell on earth.

There was a scene in the John Adams miniseries (I think it was HBO) where Mrs. Abigail Adams, infected her children with something as a inoculation (I think it was smallpox). Man, that scene was so powerful but so gross.

I find it bizarre that I can read this and then immediately think about where I'm going to lunch. My favorite infection control story is about how water fountains came to be shaped the way they are in order to provide the least amount of back wash for the next person. Yummy.

I've done some research for the nineteenth century and was also horrified at the blood-letting, burning, purging, etc. Plus they drank calomel (mercury) for certain ailments until their hair and teeth fell out. What madness?

Of course, we've done some wacky things with mercury recently, like inject it our veins with vaccines.

I have to wonder if medical community a hundred years into the future will view some of our practices as barbaric. I wonder if even 25 years from now the medical advances will be so much more sophisticated.

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